Why We Need to Talk About Premenstrual Dysphoric Disorder

Every month, I bleed (usually). My birth control pill sometimes stops that, but not always. And even the months when my period doesn’t come, the menstrual cycle still happens. Most people don’t like their periods, I mean, who wants to be actively bleeding for several days of the month, walking around like nothing is happening? Pretty much no one.

But for me, the worst part isn’t the period. It’s before. For one to two weeks before my period, I struggle immensely. I’m not just talking about the way most people with periods have cramps and bloating (which also suck); I’m talking about premenstrual dysphoric disorder (PMDD).

For a while, I didn’t realize how connected my bouts of emotional distress were to my menstrual cycle. Because I was dealing with major depressive disorder and borderline personality disorder (BPD), among other occurring illnesses, there were not many breaks in between. However, as I recovered, I realized I was having “depressive episodes” at least once a month. I wasn’t sure why this was happening, considering the huge strides I had made with all my treatment (I am even in remission from BPD). I started realizing that once my period came, the “episodes” would start to go away. And then they came back — followed by my period. I started tracking these symptoms alongside my period (or the date I would be getting my period if it weren’t for the birth control) and realized the correlation between my depression, suicidal thoughts and anxiety spiking around the 14 days before menstruation. There was a partial moment of relief — it finally made sense! Not only that, but I thought that knowing it would end once I menstruated would make it easier to tolerate.

Knowing that the pain will end did not make it much easier or make the end come any faster. It reminded me that, sure, it will end, but then it will come right back in two weeks. Sometimes it is excruciating. This morning, I woke up nauseous and ended up vomiting, dripping in sweat, heart racing and laying in a bath for three hours waiting for it to stop. I didn’t know it at the time, but I realized later that day with the help of a friend that I had a panic attack. I feel depressed. It feels like a major depressive disorder episode, but crammed all into one or two weeks. I have suicidal thoughts. Last month, I had such bad suicidal thoughts I started wondering if I would be able to stay safe. The depression and anxiety that comes with this illness feels increasingly isolated because it’s not something talked about often. I talk about major depressive disorder and generalized anxiety disorder often, but PMDD? PMDD isn’t spoken about often enough because it deals with another layer of ambiguity and stigma related to knowledge about menstruation.

PMDD is complicated. It is not well researched compared to other mental health disorders, and I think it is still highly stigmatized thanks to the old, sexist, (and trans-erasing) notions that when a woman is “acting crazy” it’s because she is “PMSing,” or that a woman acting emotional is a reason to assume it’s “her time of the month.” These ideas are harmful. They also make it harder for serious disorders, such as PMDD, to be recognized and treated. That is why I was so grateful to find the Gia Allemand Foundation. The organization was created after Gia Allemand died by suicide. She had PMDD. The Gia Allemand Foundation is the source of almost all the information I could find on PMDD. As a mental health advocate, I always felt confident in my ability to know where to go, what to do and who to see if I needed mental health help. But with PMDD, I was at a loss. And I still am.

Since PMDD is both a psychological problem and related to hormones and the reproductive system, it lies in a strange area between psychiatry/psychology and gynecology/reproductive endocrinology. The unfortunate part is that there are many OB/GYNs and psychiatrists who don’t know much about PMDD, but those two types of professionals are who you are supposed to see to get help for it. The treatment is also very much trial and error, which can leave you feeling helpless and lost while trying to get relief.

I am still looking to get the right treatment for my PMDD. Today, I don’t feel so hopeful. I feel as though it is just something I have to deal with. And that is why I decided to write this today, because it took me way too long to even see people talking about it — to know that it is something I struggle with. And I now know that I don’t want that to be the case for every single other person out there wondering why this happens to them or someone they love. You are not alone.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “HOME” to 741-741. Head here for a list of crisis centers around the world.